A disease not yet identified causes enormous damage for a few days in KISERERA west of Lake Edward in Lubero territory. The patients present signs similar to those of cholera. In the space of 4 days, at least 4 dead have been registered. And 12 people follow the care.

Diarrhea, vomiting, headache and stomach ache are some of the signs that some patients have in health centers in Kiserera. In the Graben, patients are rushed to Kamandi-Lac where there is a health post with great difficulty to treat a patient or Kamandi-Jute where there is another. The local population, through human rights activists, is sounding the alarm.

"There are no medical products in Kiserera. 4 people are already dead and 12 are undergoing care. We ask all the people who help us to maintain the road. Let these people go to Kamandi-Lac. We must be human. These people are also people just like those of Kaina, Kanyabayonga and Kirumba-Kamandi, "said Kaniki SALOMON, a human rights defender.

An administrative officer from Kamandi who we contacted responded that we must first wait before any public statement. Can we say that it is Ebola, cholera or other disease? A source close to the Kaina health zone said she plans to move around to see the reality.

Updated on February 15 at 6 p.m. ̶ In 2019, nine cases of confirmed measles have been reported to the BC Centre for Disease Control (BCCDC). Seven confirmed cases were reported in February in association with a cluster of related school-based outbreaks in Vancouver, linked to importation of measles from outside of North America.

Two unrelated adult cases were reported through separate importations in January, both returning travelers from the Philippines. All cases have been among residents of the Lower Mainland of British Columbia.

Washington State declared a state of emergency related to the measles outbreak unfolding in Clark County. The BCCDC continues to monitor the outbreak in Washington State. To date, no cases have been reported in BC related to the Washington state outbreak

Measles is preventable with vaccine

The BCCDC advises parents to ensure their child's vaccination records are up-to-date. It is especially important to ensure that immunizations are up to date prior to travel.

Measles vaccine is available as a combined measles, mumps and rubella (MMR) vaccine, and is available from your local health unit, family doctor, and many pharmacists. This will help to protect you and your family from vaccine preventable diseases.

I still have trouble understanding why such statements are needed in the 21st century in a self-styled "advanced" nation like Canada. But I also have trouble understanding why 19th-century diseases like cholera and diphtheria are flourishing around the world.

The epidemiological situation of the Ebola Virus Disease dated February 15, 2019:

• Since the beginning of the epidemic, the cumulative number of cases is 837, of which 772 are confirmed and 65 are probable. In total, there were 533 deaths (468 confirmed and 65 probable) and 291 people cured.

• 155 suspected cases under investigation;

• 2 new confirmed cases including 1 in Katwa and 1 in Vuhovi;

• 3 new confirmed cases deaths:

º 2 community deaths, 1 in Katwa and 1 in Vuhovi;

º 1 death at the CTE of Butembo;

• 4 new people healed, including 3 exits from the CTE of Beni and 1 from the CTE of Katwa.

/! \ The data presented in this table is subject to further changes after thorough investigation and after redistribution of cases and deaths in their health areas.

News of the response

Martin Fayulu sensitizes the population of Butembo on Ebola

• Martin Fayulu arrived in Butembo this Friday, February 15, 2019. During his popular rally, he called on the entire population to get involved by observing hygiene measures to end the Ebola outbreak.

• This Saturday, February 16, 2019, he went to coordinate the response in Butembo where the national coordinator, Dr. Aaron Aruna, presented the situation of the epidemic as well as the challenges facing the response teams, more particularly the reluctance of the community. He then visited the Ebola Treatment Center in Katwa where he expressed his satisfaction with the level of patient care and the level of organization of the response in general. He praised the competence and commitment of the national and international teams he met. He emphasized his commitment in the fight against Ebola to sensitize the population to understand that the disease exists. He recalled the preventive measures, namely to wash his hands regularly, not to touch each other while greeting each other, and go to the health center as soon as the first symptoms appear. Finally, he encouraged community leaders to lend a hand to the response teams.

Vaccination

• Since the start of vaccination on 8 August 2018, 80,104 persons have been vaccinated , including 20,547 in Beni, 20,241 in Katwa, 9,555 in Butembo, 6,076 in Mabalako, 2,746 in Kalunguta, 2,481 in Goma, 2,200 in Komanda, 2,007 in Oicha. , 1,663 in Mandima, 1,325 in Kyondo, 1,283 in Kayina, 1,157 in Karisimbi, 1,094 in Bunia, 1,064 in Vuhovi, 920 in Masereka, 772 in Mutwanga, 700 in Lubero, 590 in Rutshuru, 567 in Biena, 546 in Musienene, 527 in Nyankunde, 496 in Mangurujipa, 376 in Rwampara, 355 in Tchomia, 254 in Alimbongo, 207 in Kirotshe, 125 in Nyiragongo, 120 in Mambasa, 97 in Watsa (Haut-Uélé) and 13 in Kisangani.

• The only vaccine to be used in this outbreak is the rVSV-ZEBOV vaccine, manufactured by the pharmaceutical group Merck, following approval by the Ethics Committee in its decision of 19 May 2018.

A total of eight measles infections have been identified in Vancouver this week. Vancouver Coastal Health (VCH) Medical Health Officers determined that the first infection was acquired outside of North America. VCH is notifying people who were known to be in contact with the case, and is urging under-vaccinated or unvaccinated individuals among them to be immunized.

Last week, another, unrelated case of measles was also confirmed, bringing the total number of cases to nine this month.

One of the individuals visited the BC Children's Hospital Emergency Department while they were infectious. Those who were at the emergency department on the dates and times below could have been exposed. Most people in B.C. are immune to measles. However, if you were at the emergency department during these times and do develop symptoms of measles, please contact your family doctor, or doctor at a walk-in clinic.

• January 21, 2019 – 10am to 6:10pm

• January 23, 2019 – 4:45pm to 11:10pm

• January 24, 2019 - 8:13am to 11:40am

• February 1, 2019 - 2:05pm to 6:55pm

Measles is a highly infectious disease that spreads through the air. Close contact is not needed for transmission. The disease can also be spread through sharing food, drinks, cigarettes, or kissing an infected person.

Symptoms of measles include fever, cough, runny nose, and red eyes, followed a few days later by a rash that starts on the face and spreads to the chest. Complications from measles can include pneumonia, inflammation of the brain (encephalitis), convulsions (seizures), deafness, brain damage, and death. An infected person can spread measles before knowing they have been infected. People are infectious to others from four days before to four days after the onset of rash.

Since a number of cases have now been confirmed, there is an increased chance of unidentified exposures in the community. Those who are unimmunized or incompletely immunized are at highest risk. Two doses of measles vaccine are 99 per cent effective at preventing measles. Most cases now occur in those born after 1970 and who have had no doses or only one dose of measles vaccine.

• Influenza activity is widespread in the European Region. Specimens collected from individuals presenting with ILI or ARI to sentinel primary health care sites yielded an influenza virus positivity rate of 53%, slightly lower than in the previous week (58%).

• 46% of specimens from patients hospitalized with severe acute repiratory infection (SARI) collected in week 6/2019 were positive for influenza virus, and all were type A.

• Pooled data from 24 Member States and areas reporting to the EuroMOMO project indicated excess mortality mostly among elderly aged 65 years and above, but also in adults in the age group of 15-64 years.

2018/19 season overview

• Influenza activity in the European region, based on sentinel sampling, exceeded a positivity rate of 10% in week 49/2018 and has increased continuously into week 5/2019 after which it started to decrease. The positivity rate has exceeded 50% since week 3/2019.

• Both influenza A virus subtypes are circulating widely, with co-circulation in some countries while others report dominance of either A(H1N1)pdm09 or A(H3N2) viruses.

• Among hospitalized influenza virus-infected patients admitted to ICU wards, 40% of influenza A viruses were subtyped; of these 78% were A(H1N1)pdm09 virus. Among influenza virus-infected patients admitted to other wards, 28% of influenza A viruses were subtyped and 71% were A(H1N1)pdm09 virus.

• Over 90% of influenza A viruses detected from SARI surveillance since week 40/2018 were subtyped and 81% were A(H1N1)pdm09 virus.

• In general, current influenza vaccines tend to work better against influenza A(H1N1)pdm09 and influenza B viruses than against influenza A(H3N2) viruses and preliminary vaccine effectiveness estimates continue to support the use of vaccines. Early data suggests the vaccine are effective and estimates vary depending on the population studied and the proportions of circulating influenza A virus subtypes (e.g., higher VE in children). See data from Canada, Finland, Hong Kong, Sweden, and the United States.

• Circulating viruses remain susceptible to neuraminidase inhibitors supporting early initiation of treatment and prophylactic use according to national guidelines.

From 1 January through 31 January 2019, the International Health Regulations (IHR) National Focal Point of Saudi Arabia reported fourteen additional cases of Middle East respiratory syndrome coronavirus (MERS-CoV) infection, including three deaths. Details of these cases can be found by following the link to a separate document after this paragraph.

Of the 14 cases reported in January, eight are from three separate clusters of cases. Cluster 1 involves three cases (listed as cases 1, 2 and 3) in Riyadh Province and cluster 2 involves two cases (listed as cases 4 and 5) in the city of Jeddah. Cluster 3 involves three cases (listed as cases 11, 13 and 14) in the city of Wadi Aldwaser and is currently ongoing. More details regarding the outbreak in Wadi Aldwaser and the implementation of interventions by the Ministry of Health (MoH) in Saudi Arabia will be provided in the next update.

From 2012 through 31 January 2019, the total number of laboratory-confirmed MERS-CoV cases reported globally to WHO under IHR (2005) is 2 298 with 811 associated deaths. The total number of deaths includes the deaths that WHO is aware of to date through follow-up with affected member states.

WHO risk assessment

Infection with MERS-CoV can cause severe disease resulting in high mortality. Humans are infected with MERS-CoV from direct or indirect contact with dromedary camels. MERS-CoV has demonstrated the ability to transmit between humans. So far, the observed non-sustained human-to-human transmission has occurred mainly in health care settings.

As of 15 February 2019, there is an ongoing outbreak of MERS in Wadi Aldwaser, which includes cases 11, 13 and 14 reported in the separate document linked above. WHO will provide details of the additional cases involved in this outbreak as well as intervention measures implemented by the MoH. The notification of additional cases does not change the overall risk assessment. WHO expects that additional cases of MERS-CoV infection will be reported from the Middle East, and that cases will continue to be exported to other countries by individuals who might acquire the infection after exposure to dromedary camels, animal products (for example, consumption of camel’s raw milk), or humans (for example, in a health care setting). WHO continues to monitor the epidemiological situation and conducts risk assessment based on the latest available information.

WHO advice

Based on the current situation and available information, WHO encourages all Member States to continue their surveillance for acute respiratory infections and to carefully review any unusual patterns.

Infection prevention and control measures are critical to prevent the possible spread of MERS-CoV in health care facilities. It is not always possible to identify patients with MERS-CoV early because like other respiratory infections, the early symptoms of MERS-CoV are non-specific. Therefore, healthcare workers should always apply standard precautions consistently with all patients, regardless of their diagnosis.

Droplet precautions should be added to the standard precautions when providing care to patients with symptoms of acute respiratory infection; contact precautions and eye protection should be added when caring for probable or confirmed cases of MERS-CoV infection; airborne precautions should be applied when performing aerosol generating procedures. Early identification, case management and isolation, together with appropriate infection prevention and control measures can prevent human-to-human transmission of MERS-CoV.

MERS-CoV appears to cause more severe disease in people with diabetes, renal failure, chronic lung disease, and immunocompromised persons. Therefore, these people should avoid close contact with animals, particularly dromedary camels, when visiting farms, markets, or barn areas where the virus is known to be potentially circulating. General hygiene measures, such as regular hand washing before and after touching animals and avoiding contact with sick animals, should be adhered to. Food hygiene practices should be observed. People should avoid drinking raw camel milk or camel urine, or eating meat that has not been properly cooked.

WHO does not advise special screening at points of entry with regard to this event nor does it currently recommend the application of any travel or trade restrictions.

If you download the spreadsheet, you'll see that 10 of the 14 January MERS cases also suffered from diabetes mellitus, often with hypertension. These are very widespread conditions in Saudi Arabia. Even the tame Saudi media like Arab News fret about it: Close to four million Saudis suffer from diabetes, an 18.5% prevalence rate. It will be interesting if the February cases also show a connection with diabetes and hypertension.

The epidemiological situation of the Ebola Virus Disease dated February 14, 2019:

• Since the beginning of the epidemic, the cumulative number of cases is 835, of which 770 are confirmed and 65 are probable. In total, there were 530 deaths (465 confirmed and 65 probable) and 287 people cured.

• 221 suspected cases under investigation;

• 2 new confirmed cases in Katwa;

5 new confirmed case deaths:

º 1 community death in Katwa;

º 4 deaths in CTEs, including 3 in Katwa and 1 in Bunia;

* Correction: The 6 month old baby from Bunia could not be transferred to the Komanda CTE due to his critical condition. He remained at the Bunia Transit Center (CT) where he died.

• 4 new probable cases (historical deaths) validated in Komanda;

• 1 new person healed out of Katwa CTE.

/! \ The data presented in this table is subject to further changes after thorough investigation and after redistribution of cases and deaths in their health areas.

News of the response

Vaccination

• Since the start of vaccination on 8 August 2018, 79,774 persons have been vaccinated , including 20,547 in Beni, 20,185 in Katwa, 9,351 in Butembo, 6,076 in Mabalako, 2,746 in Kalunguta, 2,441 in Goma, 2,200 in Komanda, 2,007 in Oicha. , 1,663 in Mandima, 1,325 in Kyondo, 1,283 in Kayina, 1,157 in Karisimbi, 1,094 in Bunia, 1,064 in Vuhovi, 920 in Masereka, 772 in Mutwanga, 700 in Lubero, 590 in Rutshuru, 567 in Biena, 546 in Musienene, 527 in Nyankunde, 496 in Mangurujipa, 355 in Tchomia, 346 in Rwampara (Ituri), 254 in Alimbongo, 207 in Kirotshe, 125 in Nyiragongo, 120 in Mambasa, 97 in Watsa (Haut-Uélé) and 13 in Kisangani.

• The only vaccine to be used in this outbreak is the rVSV-ZEBOV vaccine, manufactured by the pharmaceutical group Merck, following approval by the Ethics Committee in its decision of 19 May 2018.

Annual vaccination against seasonal influenza is recommended for all U.S. persons aged ≥6 months. Effectiveness of seasonal influenza vaccine varies by season.

What is added by this report?

On the basis of data from the U.S. Influenza Vaccine Effectiveness Network on 3,254 children and adults with acute respiratory illness during November 23, 2018–February 2, 2019, the overall estimated effectiveness of seasonal influenza vaccine for preventing medically attended, laboratory-confirmed influenza virus infection was 47%.

What are the implications for public health practice?

Vaccination remains the best way to protect against influenza and its potentially serious complications. CDC continues to recommend influenza vaccination while influenza viruses are circulating in the community.

A group of residents ransacked Friday, February 15, the hand-washing device placed at the barrier of Mambasa-center (Ituri). According to local sources, these protesters would oppose the vaccination of medical staff launched since Thursday at the general reference hospital of Mambasa.

Other sources indicate that some residents are also protesting against the importation of labor into Ebola response activities to the detriment of the local population facing unemployment.

According to the police commander in Mambasa territory, Colonel Prosper Zombo, a mixed police-FARDC team quickly intervened to disperse the protesters.

Police and military fired several shots in the air. A lady, the wife of a soldier, was wounded by a stray bullet in the chest.

Since shortly before noon, the situation is calm again, says the police.

The administrator of the territory convened in the morning a meeting of security committee enlarged compared to this tension which prevailed in his entity.

Health Minister Oly Ilunga proceeded on Wednesday, February 13, in Kinshasa, at the launch ceremony of the strategic response plan phase 3 to combat the Ebola virus epidemic (SRP 3), which is rife in the provinces of North Kivu and Ituri.

How to find ways and means to mobilize the necessary funds for the next six months? This was the focus of an interview between international donors, UN agencies and non-governmental organizations. This project aims to stop the spread of the virus and stop the spread of the disease in other DRC risk provinces and neighboring countries.

For his part, the Minister of Health, Oly Ilunga, stressed that the DRC needs more than 147 million dollars to continue to face this epidemic, before adding that this epidemic has already affected 823 people including 517 death on 12 February 2019.

For his part, the acting representative of the WHO / DRC, Dr Deo Nshimirimana, welcomed the availability of donors for the adequate financial support in the Emergency Contingency Fund, starting in August 2018.

He also recalled that this initial funding from the WHO Contingency Fund, already injected into ongoing operations, is at an extremely low level and requires urgent replenishment.

"The financial means are among the major challenges on the ground to fight against this disease," he said Dr. Deo Nshimirimana.